| NPI | 1760786982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD468627) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: DE C1-0013330) |
| 207W00000X Ophthalmology (Licence: NJ 25MA10681700) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: PA MD468627) | |
| Enumeration Date | 2011-01-03 |
| Last Update Date | 2020-12-29 |